The Mental Health Concordat

18th February 2014

Dear All,

Today marks a historic day. The launch of the first Mental Health Concordat. I am delighted to have been involved in the work leading up to today. Over the past few months we have seen several new initiatives and research in relation to mental health provision in England. These build on the Bradleyand Adebowale reports and the HMIC report “A criminal use of police cells”

MIND and Victim Support have published a fascinating and harrowing documentlinking persons who are mentally ill to an increased likelihood of becoming a victim. The report also highlights that victims of crime who are mentally ill have a lesser experience from law enforcement agencies than most. It is essential reading for all law enforcement professionals and PCC’s.

CQC published their report Monitoring the Health Act 2012/13, which highlights the continued rise of people with mental health issues along with the inconsistencies relating to out of hours cover.

The Government published their report called Closing the Gap, a 25 point plan to bring equity and parity between those suffering mental health as opposed to physical health issues

There is so much in the above documents I could highlight, however, I think this paragraph from the Government itself in “Closing the Gap” summarises our issues:

“People who use mental health services, and those that care for them, continue to report gaps in provision and long waits for services. There is still insufficient support within communities for people with mental health problems. In some areas there have been stories of people of all ages being transferred sometimes hundreds of miles to access a bed. We are not yet making an impact on the enormous gap in physical health outcomes for those with mental health problems. And so much more could be done to promote good mental health and prevent mental ill health”

The future

Notwithstanding all of the above, today is a watershed for people in mental health crisis. The Government, and all agencies that deal with mental health crisis publish a Concordat, an agreement on what is expected of agencies in relation to people in crisis. As the Chair of the PCC Mental Health Working Group, I have signed this document on behalf of PCCs.

The very fact that we needed a Concordat displays the crux of the problem, nationally and here in Dorset - we are not getting it right. This ground breaking document acknowledges the need for the medical profession to provide sufficient resources to cope with those in crisis in their area. This translates to three key areas that are affecting policing across England on a daily basis. The medical profession need to provide sufficient beds for those in crisis and to provide sufficient mental health professional cover, 24 hours a day, 7 days a week.

It also translates to the Ambulance service providing transport for people in crisis, 24/7. The Concordat also strengthens the desire NOT to place people in crisis inside Police Custody Suites.

In 2012/13 in Dorset, 157 persons suffering mental health crisis entered Police Custody Suites. Staggeringly, this included five children 17 years old or younger.

Every one of those 157 cases represents a failure of the system, a failure of society to provide suitable safe health based care for people who are desperately ill. And it has to stop.

So what is the role of PCCs nationally?

There are two key areas for PCCs to develop, accepting that their role brings partners and people together.

1) A local solution

The issuing of the Concordat, and the numerous Government initiatives currently underway, needs to be translated to local solutions. Every PCC needs to reach agreement with their local health partners to reduce the demand on policing through improved primary and secondary mental health care. In other words, we need to convert the national Concordat to a local Concordat, signed up to by all relevant partners. In Dorset and across England, this is no mean feat. The amount of agencies and NHS Departments involved is staggering.

2) Local Governance

The provision of multi agency governance of mental health is disparate and fragmented. Some areas have fully engaged Health and Wellbeing Boards (HWB’s) with PCCs and Police sitting on them. Others (like Dorset) don’t. The problem with the HWB approach is that some areas have many HWBs for one policing area. A county wide or Force wide approach is needed.

So accepting that the governance does not necessarily have to involve HWBs, what other governance is there? Well most areas have Mental Health Boards, but membership is invariably health based and often doesn’t cover the whole policing area. That is why in some areas PCCs have set up their own Strategic Mental Health Boards, overseeing mental health provision across the Force area. Ensuring a policing voice is heard and that mental health governance becomes a multi agency approach, not just health is the second PCC challenge.

PCCs are here to not just hold Police Forces to account. When 20% of policing time is abstracted, dealing with health related issues, it is time to hold our health partners to account too